


Xenotic Events: Guidelines for Public Health Management

by imperfectcircle



Series: Stories by theme: Humour [16]
Category: The Magnus Archives (Podcast)
Genre: Canon-Typical Bugs, Canon-Typical Horror, Epistolary, Gen, No Spoilers for Season 4, and let it feast upon their flesh, background Jon/Martin vibes, full content warnings available in end notes, set mid season 3, take your fandom to someone else's work, that your own may be spared
Language: English
Status: Completed
Published: 2020-05-21
Updated: 2020-05-21
Packaged: 2021-03-03 03:00:15
Rating: Teen And Up Audiences
Warnings: Creator Chose Not To Use Archive Warnings
Chapters: 1
Words: 5,509
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/24307831
Author URL: https://archiveofourown.org/users/imperfectcircle/pseuds/imperfectcircle
Summary: The European Centre for Disease Prevention and Control (ECDC) has a long history of successfully containing and controlling suspected xenotic events.[COMMENT: Jonathan Sims] Hubris is unwise in these matters. EXPERT OPINION.-[COMMENT: Aimee Lord] Mr Sims has marked all his comments as expert opinion, possibly due to a misunderstanding of #2 in the "read me" section? @Lucy.Patel can you check whether this is clinically relevant advice or just Mr Sims being "colourful"?-[COMMENT: Lucy Patel] Mr Sims is still out of office with no known return date. Spoke to Martin Blackwood, Archival Assistant, who advised that if Mr Sims is warning against hubris, it should probably be taken seriously.
Series: Stories by theme: Humour [16]
Series URL: https://archiveofourown.org/series/338749
Comments: 96
Kudos: 505





	Xenotic Events: Guidelines for Public Health Management

**Author's Note:**

  * Inspired by [Informed Consent and Other Cosmic Ironies](https://archiveofourown.org/works/16994919) by [KiaraSayre](https://archiveofourown.org/users/KiaraSayre/pseuds/KiaraSayre). 
  * Inspired by [Beholding the GDPR: How the Magnus Institute Updated Its Privacy Policy for the Twenty-First Century And Only Caused One Nervous Breakdown In The Process](https://archiveofourown.org/works/24257458) by [shinyopals](https://archiveofourown.org/users/shinyopals/pseuds/shinyopals). 



> Full content warnings available in end notes.
> 
> Many thanks to the wonderful [soupytwist](https://archiveofourown.org/users/soupytwist/pseuds/soupytwist) for sterling beta services! All mistakes, of course, my own. 
> 
> This story owes a huge debt to [Informed Consent and Other Cosmic Ironies](https://archiveofourown.org/works/16994919) by KiaraSayre and [Beholding the GDPR: How the Magnus Institute Updated Its Privacy Policy for the Twenty-First Century And Only Caused One Nervous Breakdown In The Process](https://archiveofourown.org/works/24257458) by shinyopals, which are both heart-breaking works of staggering comedic genius.

**READ THIS FIRST:** Thank you for your support in adapting this European Centre for Disease Prevention and Control (ECDC) document for use within the four devolved health protection agencies of the UK. Your time, expertise and insight are greatly appreciated.

To help us make the best use of your valuable time, please read the following short guidance carefully before editing this document: 

1) Please ensure that any information specific to England, Northern Ireland, Scotland or Wales is clearly marked. 

2) Please cite sources clearly when they are the basis for amendments, giving at minimum full title, authorship and date (where known) for publications, including grey literature. Expert opinion is welcomed, but please indicate that this is the source.

[Aimee Lord] Attn Magnus Institute colleagues

3) Contributors unfamiliar with the Freedom of Information Act and Freedom of Information (Scotland) Act (FOIA, FOISA) are advised to read the attached guidance, _FOI(S)A_and_you_A_beginners_guide_v2.1_FINAL_2.pdf_ , before commenting on this document. 

4) [Deleted - not applicable]

5) [Deleted - not applicable]

6) The named document owner is Aimee Lord (aimee.lord3@wales.nhs.uk). Please cc guidance.admin.dev@phe.gov.uk into all communication. (Note that this inbox forwards to all four devolved agencies.) 

7) The contents of this document are considered by the document owner likely to fall wholly or largely under Section 31 of the FOIA and Section 35 of the FOISA. Please be aware that a full audit trail will be kept for internal use, and final determination of exemption will be made on the basis of public interest.

[Jonathan Sims] I think we can all agree it's in the public's best interest that the Magnus Institute's contributions are not shared more widely. EXPERT OPINION.

[Aimee Lord] Agreed.   
@Guidance.Admin.Dev - it appears Mr Sims has misunderstood #2 in the "read me" section. Please could you redraft in the template document to avoid future confusion?

[Guidance Team has marked this comment as RESOLVED]

## Xenotic Events: Guidelines for Public Health Management

#### (Adapted from ECDC Guidance A52-160)

### Contents

Acknowledgements ... ii  
1\. About this document … 1  
2\. Introduction … 1  
3\. Key principles … 2  
4\. Legal duties and powers … 3  
5\. The epidemiology of common xenotic events … 4  
6\. Initial notification … 6  
7\. Containment and control … 7  
8\. Declaring an event over … 12

Appendix 1: Safeguarding … 14  
Appendix 2: Mandatory reporting flowchart … 17  
Appendix 3: Staff mental health and wellbeing … 18

[Jonathan Sims] “Appendix 2: Mandatory reporting flowchart” has been removed. Following the amendments on pages 8 and 13, the chart becomes an Ushanka symbol, with the associated complications. EXPERT OPINION.

[Aimee Lord] @Fozia.Moorjani One for your team I think! Can you look into this? 

[Fozia Moorjani] Called the number on Mr Sims' rather alarming out of office, and spoke to Timothy Stoker. Mr Stoker shared a number of thoughts on the purpose and effectiveness of reporting frameworks for xenotic events, but was unable to confirm that the proposed new flowchart would not cause the same problems. Recommend replacing with itemised list unless Mr Sims can be contacted before document goes live. 

### About this document

This document has been adapted from the European Centre for Disease Prevention and Control (ECDC) template (https://www.ecdc.europa.eu/en/publica...ates-2017) for use in _// to be completed by devolved agencies //_.

[Calum McLeod] @Aimee.Lord Can you please review this hyperlink? The page won’t load and now my computer is filled with a sound like the distant buzzing of angry wasps and broken glass

[Aimee Lord] Are you using the internal network? It works fine for me

### Scope

This document covers the public health management of xenotic events. 

It is intended for use by trained health protection officials acting under appropriate clinical supervision and revalidation arrangements.

### Acknowledgements

_//tbc//_

[Jonathan Sims] Do not include us here. EXPERT OPINION. 

[Aimee Lord has marked this comment as RESOLVED]

### Introduction

The European Centre for Disease Prevention and Control (ECDC) has a long history of successfully containing and controlling suspected xenotic events.

[Jonathan Sims] Hubris is unwise in these matters. EXPERT OPINION.

[Aimee Lord] Mr Sims has marked all his comments as expert opinion, possibly due to a misunderstanding of #2 in the "read me" section? @Lucy.Patel can you check whether this is clinically relevant advice or just Mr Sims being "colourful"? 

[Lucy Patel] Mr Sims is still out of office with no known return date. Spoke to Martin Blackwood, Archival Assistant, who advised that if Mr Sims is warning against hubris, it should probably be taken seriously.  
Mr Blackwood does not have a direct line, but kindly provided his email address -- martin.blackwood@magnus.org.uk -- if further follow up needed.  
(FYI @Calum.McLeod, @Fozia.Moorjani)

[Aimee Lord has marked this comment as RESOLVED]

This document is intended as a guide for our partner agencies across Europe to support in the early identification and management of such events. In all cases, the ECDC must be informed as soon as possible (see Appendix 2 for mandatory reporting flowchart),

[Fozia Moorjani] Replace "flowchart" with "itemised list" per MI input.

and it is expected that the ECDC will then coordinate the public health response. 

While many of the key principles of conventional infection prevention and control are relevant to xenotic events, it is important to understand how and why xenotic events are different. 

The primary objective in conventional outbreak management is to protect public health by identifying the source and implementing control measures to prevent further spread or recurrence of the infection. The investigation and management of outbreaks and implementation of necessary control measures requires multidisciplinary expertise and collaboration. 

While the multiagency approach to the containment and control of xenotic events may follow a very similar pattern, the health protection remit is necessarily narrower. Partner agencies will take the lead on identifying and implementing local control measures,

[Jonathan Sims] "Local control measures" is an excellent euphemism. I must remember that one. EXPERT OPINION.

[Aimee Lord has marked this comment as RESOLVED]

while public health duties are limited to the containment and control of affected individuals, unless agreement is obtained in writing

[Jonathan Sims] Good luck with that. EXPERT OPINION.

[Aimee Lord] @Calum.McLeod One for you to follow up on, please? 

[Calum McLeod] I was unable to get through to Mr Sims directly, but given t bbbzzz hat this text is lifted straight from the ECDC document, it has already been vetted by their subject matter experts. Additionally, it's my department's stro bbbzzz ng view that following the events of 29/07/16 at the Magnus Institute itself (incident ref X-227482), agreement in writing is a financial must-do.

[Aimee Lord] I agree in principle, but please could you try contacting Mr Sims or one of his colleagues again, just to be sure? 

at a senior level.

[Aimee Lord] Devolved agencies to add specifics here. 

Above all, if you have cause to use this guidance, please be careful. And good luck.

[Calum McLeod] Is this appropriate lan bbbbbbzzzzzz guage for an official document?

[Aimee Lord] Yes. 

[Aimee Lord has marked this comment as RESOLVED]

[James Baker has REOPENED this comment]

[James Baker] While I'm aware that this text has been approved by the ECDC, I must echo Calum's concerns about this language appearing in official government documents.

[Aimee Lord] Thanks, James, your contributions are always appreciated! :) Just as a "friendly reminder", the four devolved health protection agencies are distinct delivery agencies with operational autonomy, and the joint agencies task and finish group agrees that this language is entirely appropriate for the subject matter. Hope this helps! :) 

[Aimee Lord has marked this comment as RESOLVED]

### Key principles

Public health specialists have a professional duty to protect and improve the population's health, and to reduce health inequalities, ensuring longer, healthier lives across the population. 

These objectives can be tested by xenotic events, and so it is important that all actions are guided by the following key principles:

1) Decisions must be made at a population level.

All decisions must take into account the risks to the whole population, not just those directly or indirectly affected by the event at the time of action. Experience teaches that once xenotic events are underway, it is hard to predict any limitations by time, person or place.

[Jonathan Sims] I can see why Gertrude liked you. EXPERT OPINION.

[Aimee Lord] @Fozia.Moorjani No follow up necessary, but I thought you might appreciate this one! 

[Fozia Moorjani] We liked Gertrude, too.

[Aimee Lord has marked this comment as RESOLVED]

2) Every xenotic event is different.

[Calum McLeod] bbbbbbbbbbzzzzzzzzzzzzzzzz

[Aimee Lord] Typo? Or perhaps one of your cats has been walking on your keyboard again? ;)  
  
I notice you haven’t commented past this point, apart from a handful of similar typos/cat contributions. Did you mean to send this version of the document? If so, not a problem, but I would be grateful if you could just drop me a line confirming sign off of appendices 1 and 3!

Conventional disease point sources are often a shared food source or a pathogen that can be identified through a shared location. Conventional transmission routes include droplet spread, faeco-oral transmission, skin contact, sexual contact, etc. Often features of the disease may indicate likely sources or transmission routes -- while this is in no way foolproof, it can give preliminary infection control a head start when faced with an unknown infection whose key symptoms are found in for example the respiratory system, digestive system, etc. 

Documented xenotic event point sources include "reading a book", "trying to access a document online" and "touching something yellow, but not really yellow? do you know what I mean?" Documented xenotic transmission routes include "making eye contact", "burning a lock of hair" and "hearing the sound of approaching wasps". 

Symptomatic presentation rarely indicates a likely source/transmission route, although thorough investigation by other agencies has been known to reveal links in hindsight.

[Jonathan Sims] Please send me the case files on transmission through eye contact. EXPERT OPINION.

[Aimee Lord] @Lucy.Patel I have a feeling that was one of ours? Can we share a redacted (for personal data, not Section 31!) version of the final outbreak report? If you can't find it on the system, Mariam may be able to help? 

[Lucy Patel] Incident reference X-101622. Since Mr Sims is away, I passed this on to Mr Blackwood, who was very grateful and says he'll make sure Mr Sims sees it as soon as he's back in the office. 

[Lucy Patel] Just to flag, Mr Blackwood called me today to let me know Mr Sims has reviewed an audio recording of the report, and believes there were at least three survivors. Have raised with Mariam Petrosian and updated the records accordingly. Unfortunately, Mr Sims' internet access is intermittent and he has not yet been able to review our follow up queries re this document, but Mr Blackwood said he would mention it next time they spoke.  
I offered to make an audio recording of our more urgent queries if Mr Sims finds this format easier to review while out of the office, but Mr Blackwood indicated this would be unlikely to be well received. 

[Fozia Moorjani] For completeness of audit trail, please note that incident X-101622 has been reopened. Further details can be found in the case notes. 

[Fozia Moorjani has marked this comment as RESOLVED]

3) Containment is essential

No natural immunity can be assumed for xenotic events. Each new xenotic event therefore has the potential to spread rapidly through a wholly susceptible global population. Natural history, transmission pattern and case fatality rate are all unknown and cannot be assumed based on perceived similarities with previous events.

[James Baker] I'm very uncomfortable with the strength of the language here. Could this be seen as scare mongering? I'm not familiar with all the ins and outs of "xenotic" events, but surely our position could be more measured? 

[Aimee Lord] Thanks, James, another really helpful contribution! :) Your department is always welcome to take a different position to that of the four devolved agencies, the ECDC, and the WHO. Hope that helps! :) 

[Aimee Lord has marked this comment as RESOLVED]

These concerns mean that it is vital to contain events by any means necessary. Strict containment measures that may appear disproportionate to the level of immediate risk are often the only way to limit untold deaths and suffering.

[Calum McLeod] bbbbbbbbbbzzzSUFFERzzzzzzzzzzzzz

[Fozia Moorjani] Calum, your cat’s contributions are my favourite thing about this project! :) So funny! 

[Aimee Lord] I agree with Fozia! It’s these little human moments that really make a project.  
Just for ease of review, I’m going to mark these accidental additions as resolved for now, but please let me know if you'd like to discuss further (or share some cat photos??) when you're back in the office.

[Aimee Lord has marked this comment as RESOLVED]

4) Assumptions cannot be made based on conventional health protection practice

When faced with dangerous and overwhelming unknowns, it can be tempting to lean on analogous experiences within conventional public health. 

This is extremely unwise. Please do not do it.

### Legal duties and powers

_// Devolved agencies to complete. Please note that the ECDC recommend using illustrative examples here. A full list of suggested scenarios can be found at https://www.ecdc.europa.eu/en/publica...ates-2017_

_The joint agency task and finish group have requested that the following three scenarios are included, as well as any others considered particularly relevant within the devolved agencies. Scenarios numbered as in ECDC document for ease of reference._

_\- Scenario #2: An individual with a visible xenotic condition that has so far shown no evidence of transmissibility (e.g. "insects living under his skin") has organised a large private event (e.g. "a wedding to his insect bride"). Public health advice is likely to be to prevent the wedding going ahead, and if this is not possible, to contain all guests until full decontamination (or other strong indication of non-transmissibility) can be guaranteed._

_\- Scenario #5: A private institute with known xenotic risk factors reports a major public health hazard (e.g. "a flesh-eating worm infestation") of indeterminate origin. Public health advice is likely to be based on the precautionary principle -- in this case, assuming xenotic risk unless otherwise strongly indicated -- and those affected may require temporary or permanent containment._

[Jonathan Sims] "Permanent containment"? Were you planning to imprison us or kill us? EXPERT OPINION.

[Aimee Lord] @Calum.McLeod One for you to follow up on, please? I believe this is a reference to X-227482.

[Aimee Lord] @Lucy.Patel In Calum's absence, would you mind taking this one?

[Lucy Patel] I was in the process of emailing Mr Blackwood when Elias Bouchard, Head of the MI, called my personal mobile. He assures me that the MI appreciates all our support with containment incident X-227482 and he will speak to Mr Sims personally about this. 

[Aimee Lord has marked this comment as RESOLVED]

_\- Scenario #10: A public body with medium risk of xenotic events shows signs of potential xenotic activity (e.g. “ominous buzzing”). Colleagues in a partner agency report suspected xenotic event and ask for assistance with risk assessment, but the ECDC cannot be contacted. Standing public health advice is to prioritise containment._

[Jonathan Sims] I suggest you also include Scenario #9 from the ECDC list. EXPERT OPINION.

[Aimee Lord] I've run this by the task and finish group, and they're happy with this. @Fozia.Moorjani could you follow up with Mr Sims?

[Fozia Moorjani] As above, spoke to Mr Stoker. His view, which he asked me to quote in full despite reminders about the limitations of Section 31/35 exclusions under the FOI(S)A, was, "Fuck it, sure, why not, eyes that bleed darkness, sounds nightmarish enough to be real." Unfortunately he was not able to supply me with any further information about why Mr Sims advised inclusion, but he did suggest, rather strongly, that we reconsider our definition of expertise.

[Aimee Lord] This has been fed back to the task and finish group for further discussion.

[James Baker] I see we're sticking to the ECDC scenarios here! That's great, but just as a suggestion, perhaps we could include some of more relevance to UK settings? 

[Aimee Lord] Thanks, James, real food for thought here! :) @Fozia.Moorjani Could you liaise directly with the MI to produce some additional scenarios for James and his team to review? 

[Fozia Moorjani] Received out of office messages from Mr Sims and Mr Blackwood, so called the main archive number and spoke to Basira Hussain, who has agreed to collate some examples for us.

[Fozia Moorjani] Further conversation with Ms Hussain highly illuminating, will send scenarios to James now for his review. Just as an FYI, Ms Hussain previously worked with the Metropolitan Police, so fully understands the context of this multiagency work. 

[Fozia Moorjani] James has asked me to let you know he no longer has capacity to be involved in this project.

[Aimee Lord has marked this comment as RESOLVED]

### The epidemiology of common xenotic events

The format of this section differs from other ECDC guidelines as it is not considered appropriate to distinguish xenotic events by aetiological agents, as the "cause" of a xenotic event is rarely obvious and often irrelevant to containment and control efforts. Instead, this section is intended to give the reader some insight into the range of xenotic events documented directly by the ECDC.

[Calum McLeod] bbbbbbbbbbzzzzzzzzzzzzzzzzITTTCOMMMESSSSSSSSSSSbbbbbbbbbzzzzzzzz

[Aimee Lord has marked this comment as RESOLVED]

#### Incubation period

Please note incubation period calculated only for those events where exposure and symptom onset are known or can be estimated with an appropriate degree of accuracy.

Known range: 

Lowest value: Instantaneous.

[Lucy Patel] Just to check in about this -- in incident ref X-200813, time between contact with agent and symptoms is described by one survivor as, "No sooner had I thought of turning the page than a terrible tremor ran up my arm. I felt as if the flesh might shake loose from my bones, and I would welcome it." Are we counting exposure T=0 as thinking about turning the page, or actually touching it? If the latter, can we consider negative incubation periods?

[Aimee Lord] This is technically out of the scope of our review process, but I'm happy for you to raise this with Sara S-B if you want to follow up. I don't want to change the main text of this section without serious cause, but we can include a footnote if Sara signs off on it.

[Lucy Patel] No need! Sara says since there are no documented cases of someone thinking about turning the page but not turning it, we can consider exposure T=0 as first thinking about it.

[Aimee Lord has marked this comment as RESOLVED]

Lower quartile: 2 days  
Median: 1 month  
Upper quartile: 6 months  
Highest value: Approx 90 years.

[Jonathan Sims] Please send me the case files for the 90 year incubation period. EXPERT OPINION.

[Aimee Lord] @Fozia.Moorjani I *think* this sat with the Robert Koch Institute? Can you follow up with our German counterparts, please?

[Fozia Moorjani] The RKI have a strict policy against data sharing with the MI. Would you like me to contact the MI directly about this? Mariam has some insight.

[Aimee Lord] Thank you but no. Mr Bouchard just called me on my wife's personal number to tell me he would instruct his colleagues to source the information through other means.

[Fozia Moorjani has marked this comment as RESOLVED]

#### Symptoms 

It is rarely possible to distinguish prodrome, syndrome and sequalae in any meaningful way for xenotic events. Symptoms observed in >10% xenotic events documented directly by the ECDC are included below.  
\- Dermatitis, often in the form of a creeping, seeping, rot-like progression spreading out from a single point on the body.  
\- Parasitic infestation with visible (possibly sub-dermal) movement. Note that this is considered a symptom and not a cause as in >50% of documented cases, the parasite appears to be spontaneously generated within the body.

[Jonathan Sims] How deeply unsettling. EXPERT OPINION.

[Aimee Lord] While it is abundantly clear Mr Sims has misunderstood which of his comments should be marked as expert opinion, I think its use here is very fitting.

[Lucy Patel] Agreed.

[Fozia Moorjani] Agreed.

[Calum McLeod] bbzzzbbbzzzz

[Aimee Lord] @Calum.McLeod Are you back from leave? Or has your cat logged in without you, haha? I hope all is well! JSYK your out of office is still on -- please let me know asap if you're happy with appendices 1 and 3. Thank you! :) 

\- Severe phobia of  
(a) dirt, mould, contamination, disease, or other health hazard  
or  
(b) basic hygiene actions, cleaning agents, fresh water, or other Water, Sanitation and Hygiene (WaSH) elements  
or  
(c) books.  
\- Oedema, effusion, and other build up of fluid, with or without external weeping/leaking. Fluid often highly thick and viscous, with typical colours yellow, green, grey and black.

#### Duration

Please note duration only calculated for those events where symptom onset and symptom end are known or can be estimated with an appropriate degree of accuracy. Due to follow up limitations, all durations >10 years have been combined into a single category. 

Lowest value: Instantaneous. Note that this is most common in events with 100% case fatality, but some lower case fatality events with duration <10s objective time have been observed.

[Jonathan Sims] Objective time has no meaning. EXPERT OPINION.

[Aimee Lord] @Calum.McLeod @Fozia.Moorjani @Lucy.Patel Not sure which one of you this should go to -- please could someone volunteer?

[Fozia Moorjani] I think this is me. 

[Fozia Moorjani] Forgot to pick this up during my call with Mr Stoker, so have used Mr Blackwood's contact details as kindly provided by Lucy above. His reply in full:  
  
"Hi Fozia,  
  
Sorry, I think that was just Jon being Jon? Probably some of your patients(?) are going to report symptoms(?) that lasted longer for them than it might have seemed from outside, but I don't think that makes objective time meaningless?  
  
I can try to ask him next time he calls, but I really do think he was just being Jon about it?  
  
Please let me know if there's anything else I can do to help. And sorry again about your conversation with Tim last week. He didn't mean it personally, he's just having a rough time at the moment.  
  
Thanks, sorry,  
Martin"  
  
Recommend leaving as written, per Aimee's comment above re high threshold for amending this section.

[Aimee Lord has marked this comment as RESOLVED]

Lower quartile: 1-2 weeks  
Median: 3 months  
Upper quartile: >10 years  
Highest value: >10 years

#### Reservoir/source

The reservoir/source of xenotic events is NOT a public health matter. Control, containment or neutralisation must NOT be undertaken by public health agencies/officers

[Jonathan Sims] Hah. You think it's not a public health matter. You think your job is clearly delimited. Public health deals with infected people, you tell yourself, not the source. Never the source. Public health sits at its desk reading into its tape recorder and complaining about its predecessor and knowing, smugly and securely, that its job may be unsettling but it's not dangerous, not really. And then before it knows it, public health is digging worms out of itself with a corkscrew and being chased through secret murder tunnels by a creature wearing a face that was never really your friend's. EXPERT. FUCKING. OPINION.

[Aimee Lord] I will follow up on this personally.

[Aimee Lord] Mr Bouchard called me on the phone of a passing stranger to inform me no follow up is needed. 

[Aimee Lord has marked this comment as RESOLVED]

unless agreement is obtained in writing at a senior level.

[Aimee Lord] Devolved agencies to add specifics here. 

For information only, reservoirs and sources observed in >10% xenotic events documented directly by the ECDC are included below. 

\- Books. Note that often these books "just showed up" or are assumed to have been left by an individual it is no longer possible to contact.  
\- Equipment used in the normal performance of health/public health duties, including but not limited to Personal Protective Equipment (PPE), surgical instruments, and common first aid supplies.  
\- Humans (alive).

[Calum McLeod] bbzzzbbbzzzz

[Aimee Lord has marked this comment as RESOLVED]

\- Humans (deceased).

#### Mode of transmission

It is strongly advised that no assumptions are made about modes of transmission during initial containment and control. Many xenotic events that may appear to be transmitted by common modes such as skin to skin contact or droplet spread are in fact transmitted by far more unusual modes, some of which are medically implausible.

[Jonathan Sims] Agreed. Transmission modes may also change dramatically within a single incident. Caution is advised in the strongest possible terms. EXPERT OPINION.

[Aimee Lord] I think this one is actually an expert opinion? @Lucy.Patel could you please follow up? 

[Lucy Patel] I'll draft something. Mr Blackwood has kindly agreed to review the text in Mr Sims' absence -- @Aimee.Lord, do you want this in the body of the text, or as a footnote?

[Aimee Lord] Given the strength of the advice, I suggest in the body, but please double-check with the MI that we're not reading too much into Mr Sims' striking language choices. 

[Lucy Patel] From my conversation with Mr Blackwood, I think we are correctly interpreting the strength of this recommendation, but I'll check when I email him the draft. 

[Lucy Patel] Text below signed off by the task and finish group in yesterday's meeting, also by Mr Bouchard, in a handwritten note pushed under my mother's door while we were on the phone. Note that I had not yet sent this through to Mr Blackwood.  
  
"Expert opinion within UK settings strongly suggests that transmission mode may change during an incident. It is the joint position of the four devolved health protection agencies that while a pragmatic focus on observed or likely transmission modes is appropriate, limitations on transmission mode must NOT be assumed during a xenotic event."  
  
@Aimee.Lord Please could you ask our colleagues at the MI not to contact my mother again? 

[Lucy Patel] Never mind. The CCTV camera by the bank has apologised to me on Mr Bouchard's behalf. The camera asked me to document that, "The MI values collaboration with the ECDC and associated agencies, and will endeavour not to overstep further."

[Aimee Lord] Dear god.

[Aimee Lord has marked this comment as RESOLVED]

#### Occurrence

Xenotic events with ECDC involvement occur at a rate of 0.5-0.7 per 100,000 population per year. Underlying incidence is estimated to be much higher, with some models suggesting events may occur at a rate of as much as 40-70 events per 100,000 population per year, or between one and two a day in a city with population 1M.

[Jonathan Sims] Highly unlikely to be this frequent. At least, I sincerely hope not. EXPERT OPINION.

[Aimee Lord] For completeness of audit trail: The four devolved agencies follow the ECDC's policy of having a much lower threshold for xenotic risk than research institutes such as the MI. 

[Aimee Lord has marked this comment as RESOLVED]

Xenotic events with ECDC involvement follow similar patterns to lab-confirmed low-risk conventional gastrointestinal (GI) diseases, with within-country higher reported incidence of pathogens in areas of greater affluence and healthcare access, and between-country higher reported incidence correlated with more established and better resourced health protection systems. 

In conventional GI epidemiology, it is well-established that underlying incidence of all GI diseases (both high and low risk) is higher in areas of lower affluence and healthcare access, and it is the the result of differential health-seeking behaviour and differential access

[Calum McLeod] bbzzzbbbzzzz

[Aimee Lord has marked this comment as RESOLVED]

to diagnostic testing (the Inverse Care Law) that means that lower risk GI diseases are more likely to be lab-confirmed in certain populations. Similarly, well-established and well-resourced health protection systems are better able to monitor lower risk GI diseases. 

It is not possible from the available evidence to conclude that the same pattern is true within xenotic events. However, the ECDC's position is that in the absence of compelling evidence in either direction, no decision should be made based on a belief in higher incidence in more affluent or better resourced areas.

[Jonathan Sims] Interesting. No such issues with the real statements, but Martin has been going on about something similar with respect to the discredited ones. EXPERT OPINION.

[Aimee Lord] I will feed this back to Mariam's team.

[Aimee Lord has marked this comment as RESOLVED]

[Aimee Lord has REOPENED this comment] 

[Aimee Lord] @Lucy.Patel Sorry, I know it's not technically your area, but would you mind following this up with Mr Blackwood (who may in fact be the Martin in question!)? 

[Lucy Patel] Not a problem! Per our offline discussion, happy to liaise with Mr Blackwood as much as necessary -- he's a pleasure to talk to. 

[Lucy Patel] Mr Blackwood expressed surprise that Mr Sims remembered this work, but is happy to share with the team later this week. He sounded pleased we were interested! 

[Lucy Patel] Mr Blackwood's work has been shared with Mariam Petrosian for onward distribution. 

[Lucy Patel marked this comment as RESOLVED]

In particular, the ECDC strongly recommends caution in interpreting the high cumulative incidence noted in many smaller, more remote villages when such events do occur, as it is unclear whether this observation is an artefact of the same potential biases discussed above, or is a feature of xenotic events.

[Jonathan Sims] By "an artefact of the same potential biases" I take it you mean problems in remote villages only come to your attention when something goes VERY badly wrong? EXPERT OPINION.

[Aimee Lord] Can someone remind Mr Sims of the limitations of S31/S35 exemptions under FOI(S)A? 

[Fozia Moorjani has marked this comment as RESOLVED]

Evidence on individual risk factors (for exposure, symptom development, or onward transmission) is highly limited, as even for events with high ECDC involvement it is often not possible to collect accurate case-level information.

[Jonathan Sims] Individual risk factors observed include dramatic irony, poor judgement, and sheer bad luck. I leave you to decide which ones apply to me. EXPERT OPINION.

[Aimee Lord] I will feed this back to Mariam's team.

[Aimee Lord has marked this comment as RESOLVED]

[Lucy Patel has REOPENED this comment]

[Lucy Patel] I flagged this comment with Mr Blackwood in case he wanted to escalate it. He has indicated this is "pretty mild for Jon" and no further action is needed.

[Lucy Patel has marked this comment as RESOLVED]

[Lucy Patel has REOPENED this comment]

[Lucy Patel] Mr Bouchard left a note tucked under my cat's collar to thank me for my concern over his employees' wellbeing. 

### Initial notification

The urgency of swift response to initial notification cannot be overstated. Local standard operating procedures (SOPs) must stress this.

[James Baker] Just a thought: perhaps you could draft a sample "SOP" here to help the reader understand what this means.

[Aimee Lord] Thanks, James, that's some real outside-the-box thinking! :) However, I think local teams would view this as vastly overstepping our limited expertise in an inappropriate and insulting manner that only really demonstrates how out of touch we are with the reality of their work. Hope this helps! :) 

[Aimee Lord has marked this comment as RESOLVED]

[Calum McLeod has REOPENED this comment] 

[Calum McLeod] bbzz EATTTT HIM? bzzz

[Aimee Lord] I think that's a matter for your team, Calum? Ha bbbzz ppy to sign off on the course of action you recommend. Sorry to nag, but since you are com bzzz menting again, could I ask you to look at appendices 1 and 3 asap please?

[Calum McLeod] bbbbzzz HE IZZZZ CONSUMEDD bzzzbzz

[Calum McLeod] bbbbzzz MANY APO bzz LOGIEZZZ FOR DELAY bzzzzzzzzz APPENDICEZZZ 1 AND 3 F bbzzzz INE bbzzzzz

[Aimee Lord] Not at all! I know it's a "buzzy" time for everyo bbzz ne.

[Aimee Lord has marked this comment as RESOLVED]

_// Devolved agencies to complete the rest of this section per guidance available at https://www.ecdc.europa.eu/en/publica...ates-2017 //_

### Containment and control

[Fozia Moorjani] @Aimee.Lord Did you mean to delete the document text from here onwards? This covers the ECDC’s major containment and control methods, which I think we can agree are pretty important!  
Just as a reminder, our new audit trail practice is to make amendments as comments rather than deleting the text from the working document and, in this case, all previous versions of the document stored on our system. I’m currently unable to access the original ECDC copy online, but will replace the missing text as soon as I’m able.

[Lucy Patel] If it helps, I have a copy of the ECDC wording stored in my email?

[Lucy Patel] Apolog bzzz ies, I can't seem to f bzzz ind it! 

[Fozia Moorjani] No worries, it can wait until the internal netwo bzz rk is up again bzz

[Lucy Patel] bzzz W E F E A S T bzzz

[Aimee Lord has marked this comment as REZZZZOLVEDDDD]

**Author's Note:**

> Thank you for reading! Comments and kudos much appreciated, and feel free to come say hi on twitter [@krfabian](https://twitter.com/krfabian).
> 
> Content notes: 
> 
> \- Wasps taking over humans  
> \- Death of OCs  
> \- Brief mentions of insect-related body horror  
> \- Discussion of disease, death, and the implication of state-endorsed murder for disease control
> 
> Some text and structure has been lifted from:
> 
> \- Foodborne disease outbreaks: Guidelines for investigation and control  
> World Health Organisation  
> https://www.who.int/foodsafety/publications/foodborne_disease/outbreak_guidelines.pdf  
> \- Communicable Disease Outbreak Management: Operational guidance  
> Public Health England  
> https://www.gov.uk/government/publications/communicable-disease-outbreak-management-operational-guidance  
> \- Pandemic flu guidance  
> Public Health England  
> https://www.gov.uk/guidance/pandemic-flu

**Works inspired by this one:**

  * [The Supervision and Oversight (Irregularities) (EU Exit) Regulations 2017: a post-exit regulatory regime for the Magnus Institute](https://archiveofourown.org/works/24436864) by [raven (singlecrow)](https://archiveofourown.org/users/singlecrow/pseuds/raven)
  * [RE: Jon Sims Complaints (edited)](https://archiveofourown.org/works/24784324) by [starcore](https://archiveofourown.org/users/starcore/pseuds/starcore)




End file.
